Periprosthetic joint infections (PJIs) are one of the most worrying complications orthopedic surgeons could face; thus, methods to prevent them are evolving. Apart from systemic antibiotics, targeted strategies such as local antimicrobial coatings applied to prosthetics have been introduced. This narrative review aims to provide an overview of the main antimicrobial coatings available in arthroplasty orthopedic surgery practice. The search was performed on the PubMed, Web of Science, SCOPUS, and EMBASE databases, focusing on antimicrobial-coated devices used in clinical practice in the arthroplasty world. While silver technology has been widely adopted in the prosthetic oncological field with favorable outcomes, recently, silver associated with hydroxyapatite for cementless fixation, antibiotic-loaded hydrogel coatings, and iodine coatings have all been employed with promising protective results against PJIs. However, challenges persist, with each material having strengths and weaknesses under investigation. Therefore, this narrative review emphasizes that further clinical studies are needed to understand whether antimicrobial coatings can truly revolutionize the field of PJIs.

Megaprostheses were introduced in oncological orthopedic surgery for reconstruction after bone tumor resections with good results; more recently, megaprostheses have been receiving an increasing role even in non-neoplastic hip and knee conditions like periprosthetic and very comminuted osteoporotic fractures and in treatment for resistant non-union of femur fractures. Nevertheless, literature about the use of megaprosthesis, especially in non-oncological musculoskeletal conditions, is still lacking high evidence level studies showing long-term outcomes. The purpose of this paper is carry out a review of the current megaprosthesis literature and present a multicenter study on a new prosthetic implant (“SMS multicentric study”), collecting the data on the use of a single implant (Smart Modularity System/SMS) in 11 orthopedic centers in order to obtain clinical and radiographic results.